Commercial laboratories perform tests on organic specimens obtained from a patient by a physician, clinic, or a hospital (hereinafter referred to as "medical provider"). The commercial laboratory can often perform the tests more efficiently than the physician due to various economies of scale. Commercial laboratories may maintain high speed, highly-automated testing equipment that would be prohibitively expensive for most medical providers. The tests performed range from routine blood chemistry through more complicated DNA procedures on specimens. Typically, the commercial laboratory will arrange for the transportation of the specimens to the laboratory, perform tests thereon, and return the results to the medical provider. The medical provider usually receives the test results within twenty-four to forty-eight hours, depending, of course, on the complexity of the test.
Commercial laboratories often maintain a relationship with medical providers through a clinical laboratory representative. Typically, the representative manages situations that may arise and provides support to medical providers to facilitate their relationship with the commercial lab. The representative may provide computer equipment, phone lines, printers, and training. However, the commercial laboratory may need to make sure that any materials provided are not used for purposes unrelated to the gathering of specimens. In many cases, the commercial laboratory would violate various laws or regulations if the commercial laboratory provided financial incentives to induce a medical provider to direct patient specimens to its commercial laboratory. Therefore, the commercial laboratory often has to avoid providing equipment that could benefit the medical provider in matters unrelated to its business with the commercial laboratory.
Numerous laws and regulations govern how commercial laboratories may be reimbursed. In the "account bill" method, the medical provider pays the commercial laboratory and collects the payment from the patient. The medical provider may charge the patient more than the laboratory bills the medical provider, thereby realizing a profit from the transaction. Often, insurance billing methods, including Medicare and Medicaid, however, eliminate the medical provider from the billing procedure. Some laws may require that the commercial laboratory directly bill the insurance provider. The purpose of these laws is to reduce a medical provider's incentive to order unnecessary tests.
One unintended effect of these restrictions is that commercial laboratories often encounter difficulties obtaining patient billing information from medical providers. Each time a patient visits the medical provider, the medical provider updates the patient demographic data, including address, age, name, employment, and the patient insurance data. This updated demographic is part of the patient encounter data obtained from the patient when visiting the medical provider. The commercial laboratories need the demographic data to properly process the specimens and bill the patient's insurance provider.
Currently, many commercial laboratories obtain patient data on 81/2.times.11 forms known as "requisitions." The requisition form is typically divided into three sections. The first section may contain patient demographic data, such as date, time, name, sex, date of birth, identification number, and address. The second section may contain insurance billing formation. The third section likely includes the tests to be performed on the specimen. However, medical providers are often unwilling to commit resources to update the patient demographic data for the commercial laboratories when the medical providers receive no compensation for their effort. This reluctance on the part of the medical providers makes it difficult for the commercial laboratories to effectively bill the patient's insurance provider.
Often, the commercial laboratories have couriers who retrieve the patient specimen and associated requisition forms from the medical provider on a daily basis. In many cases, the specimens are sent to a branch facility where they are labeled. Employees at the branch facility may then enter the patient data from the requisition form into the commercial laboratory's computer system and then transfer the specimens to the central laboratory. The central laboratory then accesses the data entered in its computer system when processing the specimens. Absent quality control procedures for data entry, errors may result.
In prior art systems, the medical provider might have communication equipment to receive the test results from the commercial laboratory. The communication equipment would often be a teleprinter or other similar device having preprinted forms coupled to a custom modem. The commercial laboratory would transmit test results to the medical provider's office and the teleprinter would then print the results. As an alternative, the medical provider may have a personal computer, including a modem and software, which the medical provider uses to obtain test results from the commercial laboratory's computer via a modem.
As an alternative, it is also possible to couple the commercial laboratory and the medical provider's computer systems. The commercial laboratory typically has a mainframe or network computer system. The medical provider would generate the pertinent data for a specimen, then transmit that data to the commercial laboratory's computer system via a modem. The medical provider could then use its computer to obtain any test results from the commercial laboratory's system via a modem.
One particular problem in this alternative is developing a suitable interface to couple the medical provider's Office Management System ("OMS") and the commercial laboratory's system. Many OMS systems are proprietary or UNIX based and the developer of the OMS system is often unwilling to develop a suitable interface for commercial laboratories. Another problem is the additional hardware that may be needed to support a network interface between the commercial laboratory and the medical provider's OMS. Such an interface may require additional ports and hardware enhancements, including additional memory and disk drives. The medical provider may be unwilling to pay for such hardware. Furthermore, in some cases, in order to add a node to the OMS network the commercial laboratory may have to add eight ports just to obtain one interface to the OMS system.
Providing additional hardware that the medical provider could use for its own benefit unrelated to operations concerning the commercial laboratory may be considered an illegal inducement. Furthermore, the commercial laboratories are often required by law to maintain ownership of all equipment the provide to the medical provider. Ownership may create problems if the commercial laboratory provides hardware upgrades and memory to the medical provider's system. The commercial laboratory would likely have to remove such upgrades from the medical provider's system if the medical provider subsequently changed commercial laboratories. Consequently, in many cases, requisition forms including patient demographic information are usually retrieved by courier and taken to a branch facility wherein the requisition data is entered into the commercial laboratory's computer system.